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Title: The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study.
Austin Authors: Weinberg, Laurence ;Lee, Dong-Kyu;Gan, Chrisdan;Ianno, Damian J ;Ho, Alexander;Fletcher, Luke R ;Banyasz, Daniel;Tosif, Shervin ;Jones, Daryl A ;Bellomo, Rinaldo ;Karalapillai, Dharshi 
Affiliation: Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Guro-Gu, Seoul, 08308, Republic of Korea
Surgery (University of Melbourne)
Intensive Care
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
Issue Date: 7-Jan-2021 2021-01-07
Publication information: BMC Surgery 2021; 21(1): 31
Abstract: It is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO2 during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes. A retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO2 and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery. 289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m2). At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO2 changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r2 = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO2 the plasma potassium concentration increased by 0.18 mmol/L. In patients receiving laparoscopic abdominal surgery, there is an increase in PaCO2 at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes. Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).
DOI: 10.1186/s12893-020-01034-w
ORCID: 0000-0001-7403-7680
PubMed URL: 33413263
Type: Journal Article
Subjects: Anaesthesia
Appears in Collections:Journal articles

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